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Moderate-severe primary graft dysfunction after pediatric heart transplantation
Katie L Mowers1, Kathleen E Simpson1, Avihu Z Gazit1
1Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri.
Pediatric Transplantation
|January 5, 2019
Summary
Prolonged cardiopulmonary bypass (CPB) time increases the risk of primary graft dysfunction (PGD) after pediatric heart transplantation. PGD significantly reduces survival rates in these young patients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Primary graft dysfunction (PGD) is a serious complication following pediatric heart transplantation (OHT).
- The lack of a standardized PGD definition in children hinders accurate assessment of its prevalence and impact.
Purpose of the Study:
- To define and evaluate the incidence and risk factors of PGD in pediatric OHT recipients.
- To assess the impact of PGD on survival outcomes in this population.
Main Methods:
- Retrospective application of ISHLT PGD consensus guidelines to 208 pediatric OHT recipients (2005-2016).
- PGD defined by inotrope score >10 or need for mechanical circulatory support (MCS) within 24 hours post-operatively.
- Multivariate analysis to identify risk factors for PGD.
Main Results:
- PGD occurred in 16.3% of patients, with severe PGD in 6.7%.
- Increased cardiopulmonary bypass (CPB) time, Fontan palliation, and post-cardiotomy myocardial dysfunction (PCM) were significant risk factors for PGD.
- PGD was associated with decreased discharge survival (85% vs 96%) and poorer 1-year survival for severe PGD (57% vs 91%).
Conclusions:
- Prolonged CPB time is a significant risk factor for PGD in pediatric OHT.
- Infant recipients and donor characteristics were not associated with increased PGD risk in this study.
- PGD negatively impacts survival outcomes in pediatric heart transplant recipients.
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